The Organ Waiting List System Could Be Made More Fair
The earliest the new regulations could go into effect would be mid-March 2000, but further delay is likely as Congress plans to reconsider the issue as part of a bill to reauthorize the National Organ Transplant Act.
Congress, with the support of many of the nation's transplant surgeons and centers, may consider legislation that would strip the government of much of its current authority over organ procurement. Such legislation would fly directly in the face of the IOM recommendations to Congress.
Politics in Washington and in the field of transplant medicine are fueling debate over the proposed changes. "The issue regionally is competing OPOs," says Frederick Gordon, MD, director of hepatology and medical director of the liver transplant program at the Lahey Clinic in Burlington, Mass.
In an interview with WebMD, Gordon says that he generally supports the Final Rule, but understands why some OPOs are nervous about the prospect of change: "I think there's some potential for improvement in areas where there are OPOs that are geographically close and are competing for the patients in the same distribution region. If there are some changes, however, there is a risk that if you're going to abolish competition among OPOs and there's a massive program in the same city with a tiny OPO, that little program is going to go out of business."
Marsha Jacobson, chief operating officer of the New England Organ Bank, says, "What is being proposed is very similar to what we have been doing for a long time in New England, which is wide sharing of organs, and we believe it works for donor families, and for recipients, so I think there's a lot to be said for [the proposed HHS regulations]."
"In essence, you don't even have to change the organ procurement organizations -- all you have to do is to promote broader sharing amongst them," Gibbons tells WebMD. He says that initial concerns about the HHS rule came about largely through misunderstanding of how the system would be revised. "People thought that there was going to be a national system and that livers, hearts, and lungs would be flown from Maine to California, which of course is ludicrous, given [the length of time an organ can be kept on ice before it begins to deteriorate]. I think we couldn't have asked for a nicer result for the analysis to come out and show that as soon as the population base hits about 9 million people, all of the 'geographic inequities' tend to go away. This is a very simple solution and it's not hard to implement it."
Meanwhile, approximately 62,000 people are waiting for donor organs, and a new name is added to the list every 16 minutes.